The arguments against Medicaid expansion are illogical and transparent attempts at opposing Obamacare.

Not only did Missouri pass a law prohibiting trained navigators from speaking to people who currently have insurance bought from an insurance agent, they also are not allowed to give consumers (who may have little to no experience with insurance plans) advice about the benefits, terms and conditions of the health care plans in the marketplace.

Paula M. Gianino, President and CEO, Planned Parenthood of the St. Louis Region and Southwest Missouri

St. Louis Post-Dispatch – November 18, 2013

The letter titled “Planned Parenthood is behind de facto takeover of Komen Foundation” (Nov. 13) is filled with misleading and inaccurate information.

Here are the facts: In early 2012, the Susan G. Komen for the Cure Foundation announced it would no longer fund Planned Parenthood’s breast cancer screening and education programs. Planned Parenthood and thousands of those committed to fighting breast cancer were alarmed and saddened to learn that some of Komen’s leadership appeared to have succumbed to political pressure regarding this announcement.

As Oct. 1 nears, bringing with it the opportunity for uninsured Missourians to buy an affordable health care plan in the marketplace, it’s hard to ignore the harsh consequences for others who will be left out since the Missouri legislature did not expand Medicaid in 2013.

On Oct. 1, individuals and families who are considered to be between 100 and 400 percent of the Federal Poverty Level (FPL) will be issued discounts or advanced tax credits by the federal government to help them afford these plans.

Sadly, there will be no financial assistance for Missourians who fall below 100 of the FPL. According to the research done by the Missouri Budget Project, this will leave out about 267,000 uninsured Missourians who would have been covered under Medicaid expansion.

The only valid part of John Lilly’s position on Medicaid (“End child poverty by ending Medicaid births,” Sept. 11) is its acknowledgment of child poverty as a serious problem in southwest Missouri.

I agree that child poverty is a problem, and it will require a complicated, comprehensive solution, but Lilly’s outdated, inaccurate and unoriginal argument against Medicaid only takes us further away from finding that solution.

Just days before new online health insurance markets are set to open, the Obama administration Wednesday released a look at average premiums, saying rates in most states are lower than earlier projected — and that 95 percent of consumers will have at least two insurers to choose from.

What is the takeaway here? We’re talking, and they’re listening! Sex education and access to birth control are having statistically significant impacts on our at-risk youth. It is not that we aren’t having babies anymore; in fact, the birth rate for women in their older 20s and 30s is increasing. We’re just getting smarter about how and when we have children, thanks to the education and resources available. This is just another victory for preventive care.

Editor, the Tribune: As the attack on women’s health continues to be pushed through legislatures around the country, politicians continue to vocalize scientifically false and offensive views.

Our own Sen. Brian Nieves (R-Washington) was recently in the news on both the state and national level for his comments regarding abortion. On his Facebook page, Nieves mocked the need for life-saving abortion, going so far as to say that an abortion to save a woman’s life is “a matter of convenience.” Convenience? Abortions to save a woman’s life are a matter of life and death.

I am growing tired of insensitive views spewing from politicians who lack medical degrees, compassion, and who dismiss the complications that can occur during pregnancy that put a woman’s life at risk. Some politicians actually think that when considering laws banning abortion, weighing whether or not to save a woman’s life is merely about “convenience.”

“In Congress, I have voted over 30 times to repeal, diminish, or defund the President’s Affordable Care Act.” This is a quote from Congresswoman Vicky Hartlzer who represents Columbia, Missouri in Washington, D.C.

Sigh.

The ACA has granted so many needed protections, protections that specifically impact women. Under the ACA women will receive preventive care without co-pays, and we will not be told anymore that pregnancy or domestic abuse is a “pre-existing condition.”

Thank you for your honesty and bravery in publishing your editorial on empty pro-life rhetoric (“Culture of lies,” July 17).

It is shameful that when the Missouri Legislature had the chance to pass Medicaid expansion (a policy that would actually save lives), they chose instead to endorse more needless restrictions on reproductive health care. Fortunately, community health care providers, such as Planned Parenthood, are continuing to make quality care affordable and accessible to those with few other options.

Instead of chasing ideological fantasies to score votes, our representatives should focus on implementing reality-based solutions to the problems facing our state. Passing the Comprehensive Sex Education Act and expanding access to contraception and prenatal care would be good starts to improving infant and maternal health outcomes, lowering the rate of unplanned pregnancies (and thus abortions), and ameliorating the quality of life and health of all Missourians.

Whatever you think about reproductive choice, I think we can all agree that is a positive goal to work toward.

Missouri is part of the “culture of some life” trend. House Bill 400 was not signed by Gov. Jay Nixon. The Democratic governor’s inaction causes it to become law on Aug. 28.

The measure effectively prohibits the use of telemedicine for abortions using abortifacient drugs by making it mandatory that a doctor be in the room for the initial dose of the drug. Opponents argued that the medical procedure is safe and that requiring a doctor will be particularly difficult for women in rural Missouri who often have to drive long distances to see a doctor in person.

The argument by proponents that this merely protects women’s health is bogus. It is another harmful restriction that does nothing to prevent unintended pregnancies or to help women be healthier.

Why is it bogus? Because the Legislature passed — and Mr. Nixon signed — House Bill 315. It gives more freedom to physician assistants. They no longer will have to be supervised by a doctor within 30 miles of their practice, nor will a doctor have to be present two-thirds of the time that physicians assistants are taking care of patients.

The easing of restrictions on physician assistants is possible in part because of telemedicine — but telemedicine isn’t good enough when abortion-inducing drugs are administered.

Gov. Nixon did not veto House Bill 400, legislation that restricts the use of RU-486 or other “abortion-inducing drugs.” The Governor did not want to sign the bill but by refusing to veto it, the legislation will become law. The bill bans “telemedicine services” in Missouri, which are important options for rural women.

Sen. Kurt Schaefer was asked recently on KBIA’s “Intersection” about Missourians who will remain uninsured after the legislature’s failure to expand Medicaid. He replied that in Columbia one can go to the Family Health Center and get “everything from dental care to chemotherapy there,” that uninsured people currently receive care at hospitals when needed and that “the population is generally covered, it’s a question of how you pay for it.” This reply is factually incorrect and shows a disregard for the unmet health care needs of hundreds of thousands of Missourians, including thousands in Boone County.

The Missouri legislative session ended last week and one of the many successes the state GOP is celebrating is the passage of a bill to add restrictions to the “abortion pill.” It’s one of several Republican initiatives that Planned Parenthood is now slamming in the aftermath of the session. It’s no surprise that these organizations are at odds with the Republicans at the Capitol, but now they are turning their attention to Governor Jay Nixon, who has the authority to veto the anti-abortion bill.

Today the Missouri Legislature adjourned the 2013 legislative session – a session marred by the triumph of politics over the health and safety of Missourians. After failing to adopt the federally funded Medicaid expansion, the Legislature approved restrictions on birth control and safe, legal abortion – in addition to the 12 restrictive provisions enacted in the past 3 years. In addition, the Legislature chose to divert $2.5 million in tax credits to unlicensed and discredited so called “crisis pregnancy centers.” Planned Parenthood affiliates in Missouri encourage Governor Nixon to veto the abortion restriction bill, and call on state legislators to end their campaign against women’s health.

I was delighted to read the commentary from Dr. Ed Weisbart (“Law should not put doctors’ wishes over patient health,” April 25) about doctors considering patients’ health above all else. I am so glad that there are doctors out there who put the patient first and are willing to present them with all of the legal alternatives, whether or not they agree with them.

What a shame that our representatives in Jefferson City can come up with something as draconian and arbitrary as the Denial of Care bill while at the same time punting away the main medical issue of the year: Medicaid expansion. How many thousands of doctors and patients will be affected now because Missouri is passing up federal money for health care while neighboring states gladly put it to work to strengthen their economic and physical health?

Let the doctors be doctors and let the politicians kindly please get out of their way.

As a family physician who has practiced for 34 years and treated tens of thousands of patients, I’m strongly opposed to a bill moving quickly through the Missouri Legislature that would protect my personal, religious beliefs even when I could harm a patient by withholding care because of those beliefs.

The Denial of Care bill (SB84 & HB457) would prevent any medical setting (hospital, urgent care, doctor’s office, medical school) from taking action against an employee who denied certain care to a patient due to a moral objection. I should clarify that the bill would not protect me if I were to deny any type of care based on my moral objection; I’m only protected if I object to providing reproductive health care like birth control, sterilization, and assisted reproduction.

A brutal form of cynicism lies behind the latest excuse offered by Missouri Senate Republicans for refusing to even discuss an expansion of the state Medicaid program. The proposal would extend health insurance to poor people and bring thousands of jobs to the state by leveraging billions of dollars in federal investment.

Sen. John Lamping, R-Ladue, was one of several senators to use the word “dead” to describe House Bill 700, sponsored by Rep. Jay Barnes, R-Jefferson City. The bill would both revamp the state’s Medicaid program and seek to take advantage of the promised federal money to pay for it.

Letter to the Editor – Dr. David L. Eisenberg – St. Louis Post-Dispatch

As an obstetrician/gynecologist, I applaud the editorial board of the Post-Dispatch for their well-researched and thoughtful editorial “Reducing abortion” (April 12).

The importance of barrier-free access to all methods of contraception is crucial to decreasing the unintended pregnancy rate in Missouri and nationwide. Ensuring that all women who may need emergency contraceptive pills can get them without delay is even more important because the sooner it is taken after under-/unprotected sex, the more effective it is at preventing conception. Therefore, I too, was thrilled by the court decision to make Plan B available over the counter for women of all ages.

I am saddened that proposed legislation in Missouri, a “freedom of conscience act” for pharmacists, is moving in the opposite direction and aiming to decrease access to contraception. I have taken care of women who despite every effort to prevent pregnancy find themselves needing additional protection because sometimes things don’t work out as planned. And, you don’t realize till the “morning after.” Women rely on their local pharmacy to serve them in their time of need, not force them to go elsewhere because of their pharmacy’s faith or politics.

Even though the Missouri House of Representatives has approved a budget that does not include federal dollars to expand Missouri’s Medicaid program, it doesn’t mean the expansion deal is dead in our state.

Children are not the only ones hurt by HB 700. This alternative bill also targets women. There is a provision in Jay Barnes’ bill that would eliminate the Uninsured Women’s Health Program. If this program is eliminated, approximately 40,000 women that currently receive services will lose coverage. Women who are at 100 to 185 percent of the federal poverty line are the women impacted. While women may be eligible for the exchange, 40,000 of those women will not automatically sign up for the exchange, resulting in a lapse of services. For every $1 spent on women’s health services, approximately $5 is saved. This program provides lifesaving cancer screenings, annual exams and birth control services. Why is it commonplace for women’s health to be under attack? Sexism is alive and well in the Missouri legislature, and people should be outraged.

I can’t remember such a unified business front as the one now arrayed in support of state Medicaid expansion, yet Missouri Republicans are just as solidly opposed.

In the Wednesday edition of this fine newspaper appeared an advertisement listing chambers of commerce from every corner of the state that have endorsed expansion. The Columbia chamber also has endorsed Medicaid but had not made its board of directors’ vote in time to be listed. And most notably the state chamber, a dependably conservative group joined at the hip with the Republican Party, came out the other day for expansion.

Editor, the Tribune: The Missouri House recently approved the speaker’s health care conscience bill. Of doubtful constitutionality, the passage of this bill would open up a real Pandora’s box in Missouri’s health care system. If a patient were brought into an emergency room and a doctor ordered a procedure that violated a nurse’s conscience and there were no other nurse available, I suppose the death could be considered “collateral damage” of a health care provider’s conscience. This goes a step further: that druggists may refuse to carry or dispense certain medications on grounds that providing such medications violates their conscience.

The movie “After Tiller” was featured earlier this month at the True/False Film Fest. Based on the turnout for the last screening at Jesse Hall at MU, I think it is safe to say that many people in our community had the opportunity to see this compelling movie. Many of the women and families featured in the movie made the very difficult and complex decision to end a planned pregnancy due to a fetal abnormality.

What some people might not know is that Missouri Rep. John McCaherty, R-High Ridge, has filed HB 386. This bill would ban abortions based on genetic abnormalities. These decisions need to be left to women and their families, NOT legislators.

In his letter “Morning-after pill causes an abortion” (March 2), John Wiltrakis argues that emergency contraceptives “work by destroying the fertilized egg before implantation, that is, by abortion,” asserting that the Affordable Care Act forces taxpayers and religious organizations to subsidize “life-ending drugs to women.” Taking a closer look at science and policy, both of these claims seem misinformed.

I visited Columbia during the True/False Film Fest to see the “After Tiller” documentary. This Sundance award-winning film follows four physicians who continue to provide third-trimester abortions after the assassination in 2009 of their colleague George Tiller in Wichita, Kan. In the abortion context, the third trimester starts at about 24 weeks of pregnancy.

The film is an insightful look into how these physicians make sense of their decisions to offer this controversial care. It also offers a rare intimate view into the world of patient decision-making. As the filmmakers themselves explain, the take-home message of this film is the issue is more complicated than we think. It isn’t black or white; it is gray. The doctors and patients both struggle with complex moral and ethical questions and in the end make the decisions they believe are best for their circumstances.

With the economic health of the state and the health care industry in the balance, it is time for the Missouri General Assembly to get serious about expanding Medicaid.

And it is time for voters to give their legislators a reason to step out and seriously consider opting into the federal government’s Medicaid plan. In fact, it is up to voters to give their legislators the political cover they need to take that step.

While the majority of Missourians and Republican legislators have made it clear they don’t like Obamacare, refusing the Medicaid expansion as a way to double down on that distaste is dangerous on many levels.

JEFFERSON CITY – The leader of a rural Missouri hospital warned lawmakers Monday that failure to expand eligibility for Medicaid could put institutions like his at risk of failure.

Kerry Noble, CEO of Pemiscot Memorial Hospital in Hayti, Mo., stood alongside House Minority Leader Jake Hummel to unveil legislation that would expand Missouri’s Medicaid eligibility requirements to 138 percent of the federal poverty level, as called for by the federal health care law.

If Medicaid is not expanded – and Republican legislative leaders have been less than enthusiastic about the idea – Noble said his hospital would lose around $1 million a year in federal payments that reimburse hospitals for treating uninsured patients.

Last week, Gov. Jay Nixon made his State of the State address. In his speech, he continued to provide both the economic and moral reasons to support a Medicaid expansion in Missouri. This issue seems so straightforward to me, and I am once again disappointed by the resistance of legislators to engage in a joint effort to improve the quality of life for 260,000 Missouri residents and create 24,000 jobs in the state of Missouri.

Recently there seems to be a significant amount of media surrounding the 40th anniversary of Roe v. Wade. The anniversary has increased the dialogue surrounding this issue; however, the dialogue that often results is hostile and polarized.

I believe this often stems from the absolute terms used when discussing a woman’s right to safe and legal abortion. The labels “pro-choice” and “pro-life” do not capture the complex thoughts that most Americans have on this topic. Unfortunately, these loaded labels also polarize legislators as well as the general public, resulting in proposed bills that continue to create barriers for women to obtain abortions.

Tuesday marks the 40th anniversary of Roe v. Wade. In 1973 the U.S. Supreme Court confirmed that the constitutionally protected right to privacy includes every woman’s right to make her own personal medical decisions without the interference of politicians.

In the wake of the record-breaking proposed legislation to limit access to abortion, this milestone anniversary creates an opportunity to remind state and national legislators that the issue of abortion remains a private health care decision for women. Politicians should not be involved in a woman’s personal medical decisions about her pregnancy.

Paula Gianino, president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri.

It was 40 years ago this month that the U.S. Supreme Court legalized abortion in the historic Roe v. Wade decision. This landmark ruling affirmed that the constitutionally protected right to privacy includes every woman’s ability to make her own personal medical decisions, without the interference of politicians. Four decades later, a majority of Americans still agree with the high court: Personal health care decisions should be left up to a woman.

As nurse practitioner Judith Gallagher related story after story of families or individuals who had no health insurance or had lost it – and couldn’t qualify for Medicaid in Missouri – she emphasized one common fact about each case.

“These are not people trying to get free rides from hardworking taxpayers,’’ Gallagher said, her voice rising. “These ARE hardworking taxpayers.”